By Susan Pratt Reinhardt, AIA | Reinhardt Lean Design and Consulting | AIA Colorado Editorial Committee Member
CAHED, the Colorado Association of Healthcare Engineers and Directors, hosted its annual (Virtual) Speed Networking event on November 12. Speakers from Craig Hospital, Denver Health, UCHealth, Banner Health, NV5, SCL Health, and Children’s Hospital of Colorado divided among breakout groups via Zoom to educate professionals involved in building and maintaining healthcare facilities how they are coping in these strange times and what trends are evolving today. Following are takeaways from owners and facilities managers and how architects can adapt during this rapidly changing time in hospital design.
The New Normal
Healthcare leaders stressed that today’s “new normal” is likely temporary, and that COVID-19 isn’t necessarily going to change how they design and construct facilities in the future. They emphasized the need to not overreact, but to look at each instance calmly and objectively. Most are, however, delaying larger projects in favor of making smaller repairs, while still considering updating future policies and operations. Tasks are reprioritized daily. Many facilities have also reduced non-emergent care due to the pandemic, and projects that affect patient areas have mostly been put on hold. These days, whole portions of a hospital may suddenly become overflow for new COVID patients, sneeze guards are installed for every interaction, workstations are staggered, security cameras and personnel are added, and hotel stations are scheduled instead of serving practitioners on a first-come, first-served basis. Healthcare owners admit it is a struggle to comprehend what is needed currently—they work hard to properly prioritize regular projects compared to COVID needs, which change on a daily basis.
Mechanical Systems and Maintenance
One of the largest challenges is modifying HVAC equipment to accommodate HEPA filtration and ensure COVID-negative spaces. To change one air handling unit into a HEPA unit, some owners have shut down entire hospital wings—but shutting down so much space just to make modifications is a problem as they struggle to find enough beds. Flexibility in the future will be key, from mechanical systems to the creation of universal rooms. Mechanical systems that were cheaper to build may be harder to balance for COVID-negative rooms, especially if large zones are handled by one VFD unit, making it hard to shut down capacity to do maintenance. Hospitals are simply too busy and don’t want to turn an entire wing into a bio-containment ward. What will be necessary to handle future diseases?
Maintenance is also difficult. What is contaminated and what is not? How can they balance the need to protect both the people in bed and those performing maintenance? What do you have to do or wear to change out a filter? Are they getting the right number of air changes per hour? How do you cohort an ICU room to provide for two COVID patients while keeping safety paramount? Best practices are ever-changing, and restrictions vary by county—and by the day.
Breakout areas have been created where personnel can remove masks and eat lunch socially distanced, but in general, no more than five to 10 may be in a room, even with masks. Departments need to find different ways to work together. Telemedicine has not made huge inroads into care and accounts just 10 percent for consultations. While many providers and patients do not gravitate toward telemedicine, hospitals don’t want caregivers out in the wider community. Still, therapy can occur in someone’s home, and hospitals are beginning to provide more of these services to accommodate patients outside of their facilities.
There is little mass testing for COVID unless there is an outbreak, and many healthcare facilities use temperature screening in an attempt to avoid the spread of the virus. Often, nurse practitioners screen visitors, vendors, patients, and contractors alike, sometimes relying on visual control to determine if there might be a problem as colder outside temperatures obscure results, sometimes requiring people to wait 10 minutes until a true temperature can register. There are a variety of procedures, some more restrictive than others. Some only require visitors to self-report symptoms. Others have banned staff from traveling. All find it difficult to get a clear picture of emerging COVID infections.
Serving the Whole Community
Some facilities struggle with their own unique issues related to COVID. Denver Health has typically been the hospital that cares for the unhoused population, and they formerly would welcome everyone through their doors. Now, that is not possible. They have limited hours for visitors and can’t perform take-ins how they once did—allowing the general public to wander in, use bathrooms, and hang around the cafeteria. Denver Health has since upgraded the presence of security to ensure that no one is congregating around the premises without a direct need and have closed bathrooms for public use. Instead, they have installed portable restrooms outdoors to help reduce contact with those infected.
Hospital supply chains are also in flux. It is a daily challenge to manage usage numbers and supply. Healthcare facilities have seen some increase in the domestic supply of important items, and most hope to end single-source procurement by diversifying their supply chains. They have turned away from large supplier overseas. Despite more domestic producers coming online, they still see companies move their factories across the border—an air filter company one owner depended on for years moved to Mexico.
How Designers and Contractors Can Help
Designers have been instrumental in helping owners imagine how to upgrade their facilities—for example, laying out floor plans to reveal how many beds can fit into a space. Designers, contractors, and vendors have brought new ideas to owners from other successful projects. Healthcare owners are eager to learn what has worked at other hospitals. With declining budgets and the day-to-day stress of reacting to COVID, they also better appreciate transparency and strong communication with their contractors. At the CAHED event, owners stressed that they strive to understand that surprises occur, and that they need designers and builders to be open and honest with them about cost changes as soon as possible.